NO PERMIT NUMBER 22821 I MaAina—bane LOT No. 9
NO. STREET
APPLICATION FOR PLUMBING PERMIT
u, < CITY OP C TI
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0 ' Date 10-4-68 Permit
3 LL ?QCT 14 196f �Q
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on thn;r"(,rsrnide hergqar3��gqyyc�age�s to install said prices
i a and/or fixtures in accordance wit`litthelprovi'si0nts+bfitl(eYPdtlnbidg Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises Residence
00
r3 Owner Perrotti Construction Address 2225 Grant Rd. ,Los Altos
oa
z W. L. HICKEY SONS INC. 198 Commercial St.Sunnyva
0 By ' Address
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3 F CONTRACTOR, AGENT
— < Phone 736-4938
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w w MLL:o-\bi D. Gcl\EVICH
ao State License 95122 Approved
U, PLUMBING INSPECTOR
FIXTURES NU
UNITS FEES UNITS FEES
WaterHcate �', 10V I Size q r'
Wate: Closets ,&-t) Material
Nath Tubs �', 3, a-p To Curb
Showers 2 3; To Prop. Line
Lavatories J , u-0 To Existing
Kitchen Sinks a �, p-L Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wish Trays STORM DRAINAGE
Washing Machines o2 3,v+O Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant SinksR Material &41v-
San raps TOTAL FEES
Urinals Fixture Fee d� ,tr0
Arca Drains Main Drain Fee
Water Leaders Storm Drain Fee
9p,,nklcr valves Water Sys. Fe 3.a-O
Permit Fee . v-v
TOTAL TOTAL FEE p-t)
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final